Correlation of Surrogate Markers of Insulin Resistance with Fasting Insulin in Type 2 Diabetes Mellitus Patients: A Study of Malwa Population in Punjab, India

Abstract

Context Insulin resistance (IR) and abnormal insulin secretion play a key role for the development of type 2 diabetes mellitus (DM). Aims We investigated the surrogate markers of IR, i.e., Homeostasis Model Assessment (HOMA), Quantitative Insulin Sensitivity Check Index (QUICKI), McAuley, and Fasting Insulin Resistance Index (FIRI) in type 2 DM patients. Also, fasting insulin (FI) levels were estimated in type 2 diabetics. Further, the correlation of FI with other surrogate markers of IR in type 2 DM was done. Settings and Design A hundred newly diagnosed patients with type 2 DM from Malwa population, Punjab, were considered for evaluation. Another 100 healthy individuals (age and sex-matched) were examined as controls. Methods and Material Fasting blood glucose, FI, and lipid profile were estimated, and IR was calculated using McAuley index (McA), HOMA, QUICKI, and FIRI. Statistical Analysis Used The statistical analysis was performed on the above-mentioned clinical interpretations. The Cohen’s kappa test was used to affirm the agreement. Results FI levels in patients with type 2 diabetes were significantly higher (20.8 ± 9.05 µIU/L) than controls (7.93 ± 1.01 µIU/L). IR by surrogate markers was found significant in the study group. The 76% patients with type 2 diabetes ended up as resistant to insulin by FI measurement, almost equivalent to McA, 80%; HOMA, 88%; FIRI, 88%; and QUICKI, 90%. A notable correlation was highlighted between FI and McA manifesting IR (p < 0.01, r = −0.85). We calculated the statistical correlation of FI with HOMA, QUICKI, and FIRI indices (p < 0.01, r = 0.93; p < 0.01 r = −0.92; and p < 0.01, r = +0.93, respectively). The agreement visible from Cohen’s kappa test also affirms the same (k = 0.9 for McA). Conclusion We concluded that all the surrogate markers for IR were specific when compared with FI, but in terms of sensitivity McA was found to be more sensitive as it includes markers of dyslipidemia, which is the precipitating factor of metabolic derangements so as the IR in type 2 DM.

Is there any difference in insulin resistance status between cases of benign and malignant ovarian neoplasms? A study on surrogate markers of insulin resistance in Indonesian non‑diabetic women

“…The HOMA model has proved to be a robust clinical and epidemiological tool for assessing IR (HOMA-IR) and β-cell function (HOMA-β). HOMA-IR correlates well with the HEC tests ( 94 ), with a sensitivity of 86%, specificity of 100%, and accuracy of 88% ( 66 ). No difference was found between benign and malignant cases using the Indonesian cut-off ( 63 ).…”

“…Another derived IR marker is FIRI, with a sensitivity of 86%, specificity of 100%, and accuracy of 88% ( 66 ). Among all patients with ovarian neoplasms, the present study revealed that the median score of FIRI was 0.76 (IQR: 0.54-1.35) and was not significantly different between the benign and malignant groups.…”

“…The last marker, QUICKI, has been found to have greater accuracy, stronger correlation (r=0.78), and improved positive predictive power to HEC compared with HOMA-IR (r=0.6) ( 56 , 61 , 101 ) in estimating insulin sensitivity ( 61 , 102 ). This marker has a sensitivity of 84%, specificity of 100%, and accuracy of 86% ( 66 ). The present study identified 86.5% of IR cases using this marker, similar to a prior study with a percentage of 84.4% ( 66 ).…”

“…The correlation between markers and between markers and clinical variables related to insulin sensitivity (i.e., QUICKI) and IR (FIL, HOMA-IR, HOMA-β, FIRI) as reported by prior studies (66,104) are presented in Fig. 2.…”

“…Duncan et al ( 57 ) formulated FIRI derived from FIL and FPG, which has been validated as an empirical IR index against the hyperinsulinaemic-euglycaemic clamp (HEC) ( 65 ). The original formula for FIRI in a previous study used FPG in mmol/l ( 66 ), hence the present study modified it to be adjusted in mg/dl by dividing the FPG by 18 [FPG (mmol/l)=FPG (mg/dl)/18] ( 67 ). A lower result of FIRI reflected a normal-level value, and the cut-off >0.77 denoted IR based on the AUC value in a prior study ( 68 ).…”